| Elite Family Medicine Llc | |
|
3336 E 32nd St Ste 205 Tulsa OK 74135-4454 | |
| (918) 398-0800 | |
| (918) 398-0810 |
| Full Name | Elite Family Medicine Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3336 E 32nd St Ste 205, Tulsa, Oklahoma |
| Authorized Official Name and Position | Vishal Aggarwal (MEMBER) |
| Authorized Official Contact | 9187424900 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Elite Family Medicine Llc 3336 E 32nd St Ste 205 Tulsa OK 74135-4454 Ph: (918) 398-0800 | Elite Family Medicine Llc 3336 E 32nd St Ste 205 Tulsa OK 74135-4454 Ph: (918) 398-0800 |
| NPI Number | 1992224349 |
|---|---|
| Provider Enumeration Date | 09/18/2017 |
| Last Update Date | 06/10/2020 |
| Medicare PECOS PAC ID | 8820359979 |
|---|---|
| Medicare Enrollment ID | O20180306000850 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992224349 | NPI | - | NPPES |
| 200749030B | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Vishal Aggarwal |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1295705663 PECOS PAC ID: 1254224785 Enrollment ID: I20040603001078 |
| Provider Name | Ashton Danielle Peterson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992263453 PECOS PAC ID: 1355683798 Enrollment ID: I20190503001429 |
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